术前综合评价对经尿道前列腺电切术手术效果的预测价值  

Predictive value of comprehensive preoperative evaluation for the outcome of TURP

作　　者：翁达飞 芮桦 周伟民[1] 袁雪峰[1] 李海博 秦振乾[1] WENG Da-fei;RUI Hua;ZHOU Wei-min;YUAN Xue-feng;LI Hai-bo;QIN Zhen-qian(Department of Urology,Yixing Peoples Hospital,Yixing,Jiangsu 214200,China)

机构地区：[1]宜兴市人民医院泌尿外科,江苏宜兴214200

出　　处：《中华男科学杂志》2021年第11期1011-1016,共6页National Journal of Andrology

摘　　要：目的:探讨良性前列腺增生(BPH)术前进行国际前列腺症状评分-排尿症状/储尿症状评分比值(IPSS-V/S)、尿流动力学检查[最大尿流率(Qmax)]及超声检查[膀胱内前列腺突入程度(IPP);残余尿量(PVR)]综合评价能准确预测经尿道前列腺电切术(TURP)的手术效果。方法:回顾性分析宜兴市人民医院2018年12月至2019年12月年收治的103例BPH患者的临床资料,年龄(71.92±7.73)岁,前列腺体积(58.34±15.59)ml。术前IPSS-V/S评分:(23.38±3.36)分,其中排尿期得分(14.38±2.69)分,储尿期得分9(8~10)分,V/S:1.67(1.43~1.88);尿流动力学检查Qmax:7(5~8)ml/s;超声检查:IPP 4(0~5)mm,残余尿量(117.03±20.51)ml。手术时间(83.65±14.31)min,术中出血量(55.32±18.92)ml。由同一名外科医师实施TURP手术。术后3个月回访其IPSS评分以及生活质量评分(QOL),IPSS评分改善超过50%或IPSS评分小于7以及QOL评分达到大致满意均可视为手术效果满意,否则视为手术效果欠佳。比较疗效满意组和疗效欠佳组之间各项术前检查结果的差异。结果:103例患者术后IPSS评分(5.36±1.95)分,较术前IPSS有统计学差异。疗效满意组共计71例(68.93%),年龄(71.04±7.23)岁,前列腺体积(59.68±15.79)ml, IPSS评分(23.87±3.42)分,排尿期得分(14.87±2.34)分,储尿期得分9(8~10)分,V/S:1.67(1.47~1.86),Qmax:6(4~7)ml/s, IPP:5(0~6)mm, PVR:(110.53±17.69)ml,手术时间(85.37±12.28)min,术中出血量(58.08±14.61)ml;疗效欠佳组共计32例(31.07%),年龄(76.91±8.25)岁,前列腺体积(55.38±14.73)ml, IPSS评分(22.53±3.25)分,排尿期得分(13.53±3.21)分,储尿期得分9(8~12)分,V/S:1.36(1.03~1.95),Qmax:8(7~9)ml/s, IPP:0(0~5)mm, PVR:(129.61±20.62)ml,手术时间(78.85±10.04)min,术中出血量(48.76±12.19)ml。结论:年龄较小、术前IPSS得分以排尿期症状为主、IPP较大、PVR较少、Qmax较小的BPH患者TURP的手术效果更好。Objective: To evaluate preoperative comprehensive examinations of the IPSS-voiding to storage subscore ratio(IPSS-V/S), maximum urinary flow rate(Qmax), intravesical prostatic protrusion(IPP) and postvoid residual urine volume(PVR) in predicting the outcome of transurethral resection of the prostate(TURP) for BPH. Methods: This retrospective study included 103 cases of BPH treated by TURP in Yixing People’s Hospital from December 2018 to December 2019. The patients averaged 71.92 ± 7.73 years of age, with a mean prostate volume of(58.34 ± 15.59) ml, preoperative IPSS of 23.38 ± 3.36, voiding score of 14.38 ± 2.69, storage score of 9(8-10), V/S ratio of 1.67(1.43-1.88), Qmax of 7(5-8) ml/s, IPP of 4(0-5) mm, and PVR of(117.03 ± 20.51) ml. The TURP operations were completed by the same surgeon, with mean operation time of(83.65 ± 14.31) min and intraoperative blood loss of(55.32 ± 18.92) ml. The patients were followed up for 3 months after surgery for evaluation of the outcomes based on the IPSS and quality of life(QOL) scores. Results: The postoperative IPSS was significantly improved in all the patients compared with the baseline(5.36 ± 1.95 vs 23.38 ± 3.36, P < 0.05). Based on the criteria of IPSS < 7 and general satisfaction with QOL, satisfactory results were achieved in 71(68.93%) of the patients(aged 71.04 ± 7.23 years, prostate volume: [59.68 ± 15.79] ml, IPSS: 23.87 ± 3.42, voiding score: 14.87 ± 2.34, storage score: 9 [8-10], V/S ratio: 1.67 [1.47-1.86], Qmax: 6 [4-7] ml/s, IPP: 5 [0-6] mm, PVR: 110.53 ± 17.69 ml, operation time [85.37 ± 12.28] min, intraoperative blood loss: [58.08 ± 14.61] ml), and unsatisfactory results in the other 32(31.07%)(aged 76.91 ± 8.25 years, prostate volume: [55.38 ± 14.73] ml, IPSS: 22.53 ± 3.25, voiding score: 13.53 ± 3.21, storage score: 9 [8-12], V/S ratio: 1.36 [1.03-1.95], Qmax: 8 [7-9] ml/s, IPP: 0 [0-5] mm, PVR: [129.61 ± 20.62] ml, operation time: [78.85 ± 10.04] min, intraoperative blood loss: 48.76 ± 12.19 ml). Conclusion: TURP yields bette

关 键 词：良性前列腺增生 尿流动力学 IPSS-V/S 超声检查 IPP PVR 疗效预测 

分 类 号：R699.8[医药卫生—泌尿科学]